Neurological letter from Zambia.
Neurological letter from Zambia.
复制标题
来自赞比亚的神经学信件。
DOI：
10.1136/practneurol-2013-000558
复制
发表时间：
2013
影响因子：
2.8
通讯作者：
Atadzhanov,Masharip
中科院分区：
文献类型：
--
作者：
Siddiqi,OmarK;Atadzhanov,Masharip
Tucked away in the heart of sub-Saharan Africa lies Zambia, one of the continent’s best kept secrets. Formerly known as Northern Rhodesia, Zambia was a British Protectorate until 1964 when it gained independence. It shares a border with eight other African countries, many with longstanding internal conflicts. Despite this, Zambia enjoys relative peace with a functioning democracy, free elections and status as 2012 African Cup of Nations football champions! The country is landlocked but by no means lacking water with wetlands covering nearly 20% of the terrain. In fact, Zambia derives its name from the mighty Zambezi River which arises in the North-Western Province and empties into the Indian Ocean. As a result, outdoor activities abound including kayaking, tiger fishing and spectacular wildlife viewing. This is the tropics, relatively underpopulated, with vast swaths of fertile land seemingly untouched since the dawn of time. Zambia unfortunately also lies at the heart of the HIV pandemic. It has an HIV prevalence of 13.5%, among the highest in the world. 1 The situation has improved with the availability of highly active antiretroviral therapy but HIV-associated diseases continue to overwhelm the health system across every patient population. Until very recently, the University of Zambia School of Medicine was the only medical school in the country with approximately 80 graduates per year. Of the 1327 healthcare facilities in Zambia, 85% are government-run facilities, while 9% are private sector facilities and 6% are religious affiliated (mission) facilities. The three levels of public health facilities are hospitals, health centres and health posts; the hospitals are divided into primary (district), secondary (provincial) and tertiary (central) facilities. 2 There are a number of strains on the Zambian healthcare system. It is estimated that the country has less than half the number of required healthcare workers and only a third of the recommended number of doctors to provide the required level of treatment. There continues to be a problem with physician retention due to emigration. The estimated number of doctors trained in Zambia and practising in the USA and Canada in 2002–2003 was equal to 11% of those working in Zambia. 3 To combat this shortage, particularly in rural areas, the country relies on paraprofessionals in the form of clinical officers and community health workers who form the backbone of the healthcare delivery. In many communities, traditional healers are still the first point of contact for medical conditions. It is common to receive questions on the role of witchcraft when counselling patients with epilepsy. Presently, we are the only two neurologists, both foreign trained, in this nation of approximately 13 million people. If this ratio seems overwhelming, at times it can be. As a result, our focus is not to hold outpatient clinics each day with an endless stream of patients lining the hallways. This is not an efficient use of time or resources. Instead, our focus has been on training those on the frontlines on how to treat the most commonly encountered neurological conditions. We are fortunate to be based at the University Teaching Hospital in Lusaka, the country’s only tertiary care facility with a number of available resources. University Teaching Hospital has both a CT and MRI scanner, costing approximately US $170 and $270 per scan, respectively. There is a cost sharing system, such that patients pay a share of these studies based on their level of income. Through the efforts of the World Federation of Neurology and the US National Institutes of Health, we also have a newly established neurophysiology laboratory with EEG and EMG/NCS equipment. The full …
